Impact of Adherence to Beta-Blockers in Patients With All-Comers ST-Segment Elevation Myocardial Infarction and According to Left Ventricular Ejection Fraction at Discharge: Results From the Real-World Registry FAST-STEMI.

Autor:	Giannino G; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Giacobbe F; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Annone U; Civic Hospital of Cirié, Cirié, Italy ; and., Ravetti E; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Rollo C; Department of Medical Sciences, University of Turin, Turin, Italy., Nebiolo M; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Troncone M; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Di Vita U; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Morena A; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Carmagnola L; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Angelini F; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., De Filippo O; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Bruno F; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Pancotti C; Department of Medical Sciences, University of Turin, Turin, Italy., Gaido L; Ospedale Maria Vittoria, Turin, Italy ., Fariselli P; Department of Medical Sciences, University of Turin, Turin, Italy., D'Ascenzo F; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy., Giammaria M; Ospedale Maria Vittoria, Turin, Italy ., De Ferrari GM; Department of Medical Sciences, University of Turin, Turin, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy.
Jazyk:	angličtina
Zdroj:	Journal of cardiovascular pharmacology [J Cardiovasc Pharmacol] 2024 Dec 01; Vol. 84 (6), pp. 581-589. Date of Electronic Publication: 2024 Dec 01.
DOI:	10.1097/FJC.0000000000001627
Abstrakt:	Abstract: Beta-blockers are a crucial part of post-myocardial infarction (MI) pharmacological therapy. Recent studies have raised questions about their efficacy in patients without reduced left ventricular ejection fraction (LVEF). This study aims to assess adherence to beta-blockers after discharge for ST-segment elevation myocardial infarction (STEMI) and the impact of adherence on outcomes based on LVEF at discharge. The retrospective registry FAST-STEMI evaluated real-world adherence to main cardiovascular drugs in patients with STEMI between 2012 and 2017 by comparing purchased tablets with expected ones at 1 year through pharmacy registries. Optimal adherence was defined as ≥80%. Primary outcomes included all-cause and cardiovascular death while secondary outcomes were MI, major/minor bleeding events, and ischemic stroke. The study included 4688 patients discharged on beta-blockers. The mean age was 64 ± 12.3 years, 76% were male, and the mean LVEF was 49.2 ± 8.8%. The mean adherence at 1 year was 87.1%. Optimal adherence was associated with lower all-cause (adjusted hazard ratio, 0.62, 95% confidence interval, 0.41-0.92, P : 0.02) and cardiovascular (adjusted hazards ratio, 0.55, 95% confidence interval, 0.26-0.98, P : 0.043) mortality. In patients with LVEF ≤40%, optimal adherence was linked to reduced all-cause and cardiovascular mortality, but this was not found in patients with either preserved or mildly reduced LVEF. Predictors of cardiovascular mortality included older age, chronic kidney disease, male gender, and atrial fibrillation. Optimal adherence to beta-blocker therapy in patients with all-comers STEMI reduced all-cause and cardiovascular mortality at 1 year; once stratified by LVEF, this effect was confirmed only in patients with reduced LVEF (<40%) at hospital discharge. Impact of adherence to beta-blockers in all-comers STEMI patients and according to LVEF at discharge: results from the real-world registry FAST-STEMI. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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